<!DOCTYPE html>
<html lang="en">
<head>
  <meta charset="UTF-8">
  <title>Title</title>
  <title>预交金管理-预交金信息登记</title>
  <link rel="stylesheet" type="text/css" href="../../../themes/default/easyui.css">
  <link rel="stylesheet" type="text/css" href="../../../themes/icon.css">
  <script type="text/javascript" src="../../../easyui/js/jquery.min.js"></script>
  <script type="text/javascript" src="../../../easyui/js/jquery.easyui.min.js"></script>
  <style>
    body {
      font-size: 14px;
      padding: 0;
      margin: 0;
    }
    a {
      display: inline-block;
      text-decoration: none;
      color: #000;
      padding: 0;
      margin: 0;
    }
    .form-item{
      margin-top: 10px;
    }
    .form-item label{
      display: inline-block;
      width: 130px !important;
      text-align: right;
    }
    .form-item .save{
      width: 80px;
      height: 35px;
      line-height: 35px;
      text-align: center;
      font-size: 16px;
      border-radius: 5px;
      float: left;
      cursor: pointer;
      margin-top: 30px;
      color: #fff;
      background: rgba(64, 158, 255, 1);
    }
  </style>
</head>
<body>
  <div class="container">
    <form class="form-content" id="ff" method="post">
      <div class="form-item">
        <label for="reservationNumber">团检预约单号：</label>
        <input class="easyui-validatebox" placeholder="输入" type="text" id="reservationNumber" name="reservationNumber" style="width: 270px;height: 30px;"/>
      </div>
      <div class="form-item">
        <label for="businessName">企业名称：</label>
        <input class="easyui-validatebox" placeholder="输入" type="text" id="businessName" name="businessName" style="width: 270px;height: 30px;"/>
      </div>
      <div class="form-item">
        <label for="creditCode">企业统一信用代码：</label>
        <input class="easyui-validatebox" placeholder="输入" type="text" id="creditCode" name="creditCode" style="width: 270px;height: 30px;"/>
      </div>
      <div class="form-item">
        <label for="medicalExaminersNumber">体检人数：</label>
        <input class="easyui-validatebox" placeholder="输入" type="text" id="medicalExaminersNumber" name="medicalExaminersNumber" style="width: 270px;height: 30px;"/>
      </div>
      <div class="form-item">
        <label for="medicalExaminersDate">体检日期：</label>
        <input id="medicalExaminersDate" type="text" class="easyui-datebox" style="width:250px;height: 30px;" placeholder="请选择日期">
      </div>
      <div class="form-item">
        <label for="medicalExaminersState">体检状态：</label>
        <select id="medicalExaminersState" class="easyui-combobox" placeholder="请选择" name="sex" style="width:270px;height: 30px;">
          <option>请选择</option>
          <option>男</option>
          <option>女</option>
        </select>
      </div>
      <div class="form-item">
        <label for="corporateContacts">企业联系人：</label>
        <input class="easyui-validatebox" placeholder="输入" type="text" id="corporateContacts" name="corporateContacts" style="width: 270px;height: 30px;"/>
      </div>
      <div class="form-item">
        <label for="corporateContactsPhone">企业联系人电话：</label>
        <input class="easyui-validatebox" placeholder="输入" type="text" id="corporateContactsPhone" name="corporateContactsPhone" style="width: 270px;height: 30px;"/>
      </div>
      <div class="form-item">
        <label for="handlerName">预交金办理人姓名：</label>
        <input class="easyui-validatebox" placeholder="输入" type="text" id="handlerName" name="handlerName" style="width: 270px;height: 30px;"/>
      </div>
      <div class="form-item">
        <label for="handlerPhone">预交金办理人电话：</label>
        <input class="easyui-validatebox" placeholder="输入" type="text" id="handlerPhone" name="handlerPhone" style="width: 270px;height: 30px;"/>
      </div>
      <div class="form-item">
        <label for="handlerAmount">预交金金额：</label>
        <input class="easyui-validatebox" placeholder="输入" type="text" id="handlerAmount" name="handlerAmount" style="width: 270px;height: 30px;"/>
      </div>
      <div class="form-item">
        <div class="save">保存</div>
      </div>
    </form>
  </div>
</body>
</html>
